PayerIQ
Production
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Tier 3IDCommercial

Crystal Run Health Plan

Monitor & nurture — quarterly touchpoints + data sharing

Composite
52.9
Rank
#194
Members
1.7M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
42
+10.5
Lives
20%
49
+9.8
Geography
20%
67
+13.4
Restrictions
15%
48
+7.2
Relationship
10%
36
+3.6
Financials
10%
84
+8.4
Composite Score52.9
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 10.5 + 9.8 + 13.4 + 7.2 + 3.6 + 8.4 = 52.9
Intelligence

Qualitative intelligence

Members
1.7M
Drug spend
$0.5B
Formulary
3-tier
PA / RA level
High
Biosimilar policy
Preferred substitution
Avg reimbursement
82 days
Strategic notes

Patient advocacy partnerships in market; leverage for formulary narrative

Peer set

Closest peers in Commercial

PreferredOne PPO
CA · Tier 3
52.0
-0.9
SilverSummit Healthplan
MD · Tier 3
54.5
+1.6
ConnectiCare
DE · Tier 3
54.7
+1.8
Tufts Health Plan
WA · Tier 3
50.8
-2.1
Excellus BlueCross BlueShield
MS · Tier 3
56.0
+3.1
Playbook · Tier 3

Engagement timeline

Week 2
Account manager check-in
Bi-annually
Formulary monitoring report